Coil Migration Through Skin After Posterior Tibial Artery Pseudoaneurysm Trapping

Abstract

Pseudoaneurysms arise as a complication of arterial wall injury or infection. Traumatic pseudoaneurysms can be treated nonsurgically by endovascular interventional procedures such as covered stent placement or by trapping of the parent vessel by coils, thus excluding the pseudoaneurysm or by percutaneous thrombin injection [1]. The anatomy of the pseudoaneurysm and the cost of the hardware to be used are the deciding factors when choosing the technique of pseudoaneurysm exclusion. An 18-year-old man sought care at our institute with penetrating trauma near the right medial malleolus, which he received from a sharp piece of glass while playing. Skin suturing, compression bandaging, and administering a course of antibiotics controlled consequent profuse bleeding. He developed a pulsatile swelling at this site—a few days after the stitches were removed, with occasional serosanguineous discharge from the wound. A Doppler scan revealed an approximately 1.6 cm 9 1.4 cm pseudoaneurysm communicating with the right posterior tibial artery. As a result of the wide neck, open wound and serosanguineous discharge, surgical repair was not considered. At the same time, percutaneous injection of thrombin was not considered in view of the increased risk of distal migration. Covered coronary stent placement was not a good option because the area was across the joint and